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Atrial Fibrillation - Causes and Symptoms
Atrial fibrillation is a relatively common cardiac arrhythmia that results in an irregular heart rhythm. New onset (acute) of atrial fibrillation is present when a rapid irregular pulse occurs. This may require emergency treatment with medications to slow the heart rate. Some patients will have chronic, stable
atrial fibrillation that requires daily medication to modify the heart rate. Intermittent atrial fibrillation can increase the patient's risk of stroke. In some instances, a blood clot can form inside the fibrillating atria that can be released into the general circulation (embolization). Once the clot is released from the heart, it can lodge in the cerebral circulation, and cause a stroke, or enter the lungs, and cause a pulmonary embolism. Atrial fibrillation results when multiple areas of the atria undergo electrical discharge and contraction. Synchronized electrical depolarization with uniform contraction, does not occur, instead, there is a rapid "quivering" of the atrial wall.
CAUSES OF ATRIAL FIBRILLATION
1. Hypertension (most common cause)
2. Rheumatic heart disease
3. Coronary artery disease
4. Hyperthyroidism
5. Chronic obstructive pulmonary disease
6. Pericarditis
7. Acute alcohol intoxication
8. Atrial septal defect (congenital heart disease)
9. Myocardial infarction
10. Aortic stenosis
Common symptoms of acute atrial fibrillation include shortness of breath, palpitations, faintness and fainting, and/or chest pain. Evaluation will include: cardiac enzymes, EKG and cardiac monitoring, CXR, echocardiogram, and thyroid profile. Treatment is aimed at "converting" the rhythm of the heart to a normal (regularand slower) rate. This may be accomplished with IV medications, or by electrical cardioversion in more emergency situations. Electrical cardioversion refers to the controlled, quick delivery of a DC electric shock to the heart muscle. This is performed by attaching metal electrodes (paddles) to the chest wall. The electric charge serves to "reset" the heart and allow it to return to a normal rhythm. Chronic atrial fibrillation, when it is asymptomatic, can be controlled with medications (digoxin) that slow down the heart rate. As mentioned above, atrial fibrillation can increase the possibility of blood clots forming inside the heart. In rare circumstances, this can result in stroke. medication (warfarin) to impede blood clot formation. The Cardiologist or Internist are the experts in the evaluation and treatment of atrial fibrillation.
RECOMMENDATION: Patients with atrial fibrillation should not use medications (decongestants and cold medications) that accelerate the heart rate. They should also not smoke and avoid caffeine. All patients with a cardiac condition should observe a cardiac diet low in fat and cholesterol.
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